Quality Improvement Coordinator

Quality Assurance Chicago, Illinois Park Ridge, Illinois


Description

Position at Clear Spring Health

Group1001 is a consumer-centric, technology-driven family of insurance companies on a mission to deliver outstanding value and operational performance by combining financial strength and stability with deep insurance expertise and a can-do culture. Group1001’s culture emphasizes the importance of collaboration, communication, core business focus, risk management, and striving for outcomes. This goal extends to how we hire and onboard our most valuable assets, employees.

CCAI – Community Care Alliance of Illinois

Quality Improvement Coordinator 

Chicago, Park Ridge

Company Overview:

Community Care Alliance of Illinois, Inc., now part of Clear Spring Health Holdings, LLC (CCAI) is looking for pioneering healthcare professionals, educators and administrative/support staff with expertise or interest in disability and chronic illness care who would like to help design and implement ground-breaking Medicare health plans. CCAI was created to meet the complex care needs of individuals. People with psychiatric, physical, sensory and developmental disabilities and multiple chronic illnesses in publicly funded insurance systems.  

The CCAI innovative care model will reach beyond traditional fee-for-service or managed care approaches currently available. We will integrate consumer input and governance in a full spectrum of medical and social support services. Consumers will play an active role in the organization’s programs and operations. Interdisciplinary teams with primary care providers, rehabilitation, behavioral health, nurse care coordinators, specialists, peer support and home- and community-based services will partner with patients/consumers for their care plans. This partnership will support quality treatment and prevent secondary complications while promoting health, self-determination, optimal function and community independence. CCAI will work to empower people with complex conditions to live as independently in the community as possible.

Job Summary:

Assist in quality improvement functions delineated in CCAI, Quality Management Program description.

Main Accountabilities:

  • Assists with HEDIS/medical evaluation studies including data collection, analysis, evaluation and reporting.
  • Participating in developing and implementing quality improvement interventions, including face-to-face and telephonic meetings with providers.
  • Assists in educating plan’s employees and providers about QI, HEDIS and STARS requirements. 
  • Assists with monitoring medical group corrective action plans.
  • Sends requests for medical records as needed.
  • Assists with tracking member outreach activities.
  • Assists with submission of non-compliant member reports to groups as required.
  • Attends QI/UM & PR Committee meetings.
  • Supports staff with problem solving of medical care related issues with providers.
  • Other tasks as assigned.

Qualifications:

  • Licensed Registered Nurse.
  • 2—5 years managed care experience in quality improvement.
  • Knowledge of Medicare Advantage quality requirements and Five-STAR Quality Rating System.
  • Knowledge of NCQA standards preferred.
  • Knowledge of billing codes including CPT, ICD-10 and HCPCS codes.
  • Strong analytical and problem-solving skills.
  • Strong computer skills – Microsoft Office Suite.
  • Strong communication and interpersonal skills.
  • 40% interstate travel required for this role in Illinois.